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Abstract
Objective:To compare intracytoplasmic sperm injection (ICSI) outcomes of women with subclinical hypothyroidism with those of euthyroid women.Materials and Methods:A retrospective case-control study was conducted. Out of 2529 ICSI cycles evaluated, 41 women with hypothyroidism, 28 women with hyperthyroidism, and 128 women with subclinical hyperthyroidism were excluded, and 2336 cycles were analyzed. Women were identified as having subclinical hypothyroidism (case group, n=105) in the presence of a thyroid-stimulating hormone level >4.5 mU/L and normal free T4 and compared with euthyroid controls (n=2231).Results:The mean age, body mass index, day 3 follicle-stimulating hormone level, and antral follicle count of the study patients were similar to the control group (p>0.5). The cycle cancellation rate of the study group was similar to the control group (13.3% vs. 7.6%, p=0.1). The clinical pregnancy rate was 21.2% in the study group, which was significantly lower than the 35.8% in the control group (p=0.04). The take-home baby rate was also significantly lower in the study group compared with the control groups (13.5% vs. 31.4% respectively, p=0.01).Conclusion:Both the clinical pregnancy rate and the take-home baby rate is lower in women with subclinical hypothyroidism at the time of ICSI cycle.
Highlights
Various experimental cell culture studies involving human and some animal species have shown that thyroid hormones have, to some degree, a stimulatory effect on granulosa and/or thecal cells[1,2,3]
The clinical pregnancy rate was 21.2% in the study group, which was significantly lower than the 35.8% in the control group (p=0.04)
In a recent study of limited numbers of pregnant women with subclinical hypothyroidism, T4 treatment was reported to result in similar clinical pregnancy rates per cycle but higher embryo implantation rates, live birth rates, and lower miscarriage rates compared with the no treatment group[8]
Summary
Various experimental cell culture studies involving human and some animal species have shown that thyroid hormones have, to some degree, a stimulatory effect on granulosa and/or thecal cells[1,2,3]. It is anticipated that disturbances in this thyroid-ovarian interaction might exert a negative influence on pregnancy as previously shown[4,5] In this manner, hypoor hyper-thyroidism have their own ways of management; it is not clear for subclinical hypothyroidism, which is defined as a serum thyroid-stimulating hormone (TSH) above the defined upper limit of the reference range, with a serum free thyroxine (fT4) within the reference range[6]. In contrast with this study, subclinical hypothyroidism and overt hypothyroidism was shown not to benefit from T4 treatment in terms of the clinical pregnancy rates per started cycle, implantation rates, and the live birth rates per started cycle compared with euthyroid controls[9] In this multi-centered retrospective casecontrol study, we aimed to determine intracytoplasmic sperm injection (ICSI) outcomes of infertile women with subclinical hypothyroidism versus euthyroid infertile women, including higher numbers of ICSI cycles
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